An Accurate and Explainable Deep Learning System Improves Interobserver Agreement in the Interpretation of Chest Radiograph

Abstract

Interpretation of chest radiographs (CXR) is a difficult but essential task for detecting thoracic abnormalities. Recent artificial intelligence (AI) algorithms have achieved radiologist-level performance on various medical classification tasks. However, only a few studies addressed the localization of abnormal findings from CXR scans, which is essential in explaining the image-level classification to radiologists. Additionally, the actual impact of AI algorithms on the diagnostic performance of radiologists in clinical practice remains relatively unclear. To bridge these gaps, we developed an explainable deep learning system called VinDr-CXR that can classify a CXR scan into multiple thoracic diseases and, at the same time, localize most types of critical findings on the image. VinDr-CXR was trained on 51,485 CXR scans with radiologist-provided bounding box annotations. It demonstrated a comparable performance to experienced radiologists in classifying 6 common thoracic diseases on a retrospective validation set of 3,000 CXR scans, with a mean area under the receiver operating characteristic curve (AUROC) of 0.967 (95% confidence interval [CI]: 0.958–0.975). The VinDr-CXR was also externally validated in independent patient cohorts and showed its robustness. For the localization task with 14 types of lesions, our free-response receiver operating characteristic (FROC) analysis showed that the VinDr-CXR achieved a sensitivity of 80.2% at the rate of 1.0 false-positive lesion identified per scan. A prospective study was also conducted to measure the clinical impact of the VinDr-CXR in assisting six experienced radiologists. The results indicated that the proposed system, when used as a diagnosis supporting tool, significantly improved the agreement between radiologists themselves with an increase of 1.5% in mean Fleiss’ Kappa. We also observed that, after the radiologists consulted VinDr-CXR’s suggestions, the agreement between each of them and the system was remarkably increased by 3.3% in mean Cohen’s Kappa. Altogether, our results highlight the potentials of the proposed deep learning system as an effective assistant to radiologists in clinical practice. Part of the dataset used for developing the VinDr-CXR system has been made publicly available at https://physionet.org/content/vindr-cxr/1.0.0/.

Keywords

• Chest X-ray interpretation
• deep learning
• image classification
• object detection